CMS pitched a 2.8 percent average rate increase for ASCs next year in the 2024 hospital outpatient prospective payment system, released July 13.
Five things to know:
1. CMS proposed a 3 percent inflation update factor for both ASCs and hospital outpatient departments next year, and applied a 0.2 percentage point productivity reduction, as required by the ACA to arrive at the 2.8 percent pay increase. The conversion factor for ASCs is $53.397, compared to HOPDs at $87.488, according to an analysis from ASCA.
2. In agreement with the Ambulatory Surgery Center Association's request, CMS plans to extend the five-year interim period of using the same pay update factor for ASCs and HOPDs by two years, through 2025, due to many patients avoiding elective procedures during the COVID-19 pandemic. CMS hopes the extension will allow it to more accurately assess whether applying the hospital market basket update to ASC pay affects services migrating to the ASC from hospitals.
3. Under the proposed rule, CMS aims to add 26 dental surgical codes payable for ASCs next year. ASCA pitched 62 other surgical codes to add next year, but CMS declined to add them. Among the codes pitched was total shoulder replacements, which are routinely performed in ASCs for non-Medicare patients, according to ASCA.
"It is mystifying to me that CMS allows off-campus hospital outpatient departments to perform total shoulder surgeries yet prohibits similarly regulated surgery centers — served by identically trained surgeons, nurses and other staff — from performing them on even the otherwise healthiest patients," Bill Prentice, CEO of ASCA, said in a news release. "By refusing to rely on the clinical expertise of surgeons, who are clearly the best positioned to determine the appropriate site of care for each patient, CMS is wasting millions of dollars each year by trapping care in higher-cost settings."
4. Changes to the ASC quality reporting program under the proposed rule include:
- Readopting ASC-7: ASC facility volume data on selected ASC surgical procedures
- Adopting ASC-21: Risk standardized patient reported outcome-based performance measure following elective primary total hip arthroplasty and/or total knee arthroplasty in the ASC setting
- Modifying ASC-11: Cataracts visual function, which will remain voluntary
5. CMS proposed keeping the ASC-20: COVID-19 vaccination coverage among health care personnel reporting requirement within the program, which ASCA opposes.
"Clinicians in the ASC community recommended that more than 60 procedure codes be added to our Medicare payable list and CMS has proposed to add none of them," Mr. Prentice told Becker's. "We are extremely frustrated that CMS continues to use the utterly mysterious and undefined term 'typical Medicare beneficiary' when determining whether to add procedures to the list. Surgery centers are specifically designed to treat the subset of patients whose underlying overall health, as determined by their surgeon, makes them good candidates for care in our setting. Until CMS recognizes that, the Medicare program will waste untold millions of dollars each year by trapping care in higher cost settings."